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Role of Placenta Accreta Index for Diagnosis of Placenta Accreta Spectrum in High-Risk Patients
Sugandha Bansal1, Jyotsna Suri1, S K Bajaj2
1Department of Obstetrics and Gynecology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, 110029 India.
Insights
The placenta accreta index (PAI) effectively screens high-risk pregnancies for placenta accreta spectrum (PAS). A PAI score of 4.75 or higher strongly suggests PAS, aiding in timely diagnosis and management.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Diagnostic Imaging
Background:
- Antenatal diagnosis of placenta accreta spectrum (PAS) is crucial for multidisciplinary management and reducing maternal/fetal complications.
- A standardized scoring system is needed for accurate PAS diagnosis and management.
- The placenta accreta index (PAI) aims to provide such a standardized criterion.
Purpose of the Study:
- To assess the efficacy of the placenta accreta index (PAI) and its individual parameters in diagnosing PAS.
- To evaluate PAI's diagnostic performance in high-risk pregnant patients.
Main Methods:
- A prospective study involving 71 pregnant women with placenta previa and prior cesarean sections.
- Ultrasonography was used to calculate the PAI for each participant.
- Definitive diagnosis was confirmed intraoperatively or via histopathology.
Main Results:
- All ultrasound parameters of the PAI were statistically significant in predicting PAS (p < 0.001).
- The optimal cutoff value for diagnosing PAS was determined to be 4.75, with an AUC of 0.87.
- The PAI demonstrated a sensitivity of 73.3%, specificity of 95.1%, and diagnostic accuracy of 85.9%.
Conclusions:
- Pregnant women with placenta previa and a history of cesarean section should be screened using the PAI.
- A PAI score of ≥ 4.75 warrants a high index of suspicion for PAS, facilitating prompt clinical intervention.
Background:
Antenatal diagnosis of placenta accreta spectrum (PAS) can ensure multidisciplinary management at center of excellence which can reduce maternal and fetal complications. This can be established by a scoring system which provides a standardized criterion for the diagnosis and management. The objective of our study was to assess the placenta accreta index (PAI) and its individual parameters for diagnosis of PAS in high-risk patients.
Methods:
A prospective study was conducted on 71 pregnant women with placenta previa and previous cesarean section. After informed consent, history was taken and ultrasonography was used to calculate the PAI for each patient. Definitive diagnosis was made clinically during cesarean section or by histopathology for those requiring hysterectomy. The data were evaluated using the latest version of Statistical Package for the Social Sciences software.
Results:
All ultrasound parameters of placenta accreta index were statistically significant for predicting PAS (p value < 0.001). ROC curve with AUC of 0.87 95% CI of 0.77-0.94 showed that a score of 4.75 was the best cutoff value to diagnose PAS. Out of the 30 patients found to have placental invasion, 22 had a PAI score of more than 4.75. The score was found to have a sensitivity of 73.3%, specificity 95.1%, positive predictive value 91.7%, negative predictive value 83% and diagnostic accuracy 85.9%.
Conclusions:
Women with placenta previa and history of previous CS should undergo screening by PAI, and a cutoff value of ≥ 4.75 should be viewed with high index of suspicion for the presence of PAS.
